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The UK is “a long way” from achieving its targets for reducing antimicrobial-resistant infections, according to a report by the National Audit Office (NAO).
The report, published on 26 February 2025, assessed the risk posed by antimicrobial resistance (AMR) and the UK government’s response.
It noted that, despite government targets, there had been “no sustained reduction” in the amount of AMR-related human infections that the government tracks.
In its AMR national action plan for 2019–2024, published in January 2019, the Department of Health and Social Care (DHSC) aimed to reduce human drug-resistant infections by 10% between 2018 and 2025.
“However, by 2023, infections in England had risen to 13% above the 2018 baseline,” the report said.
The UK Health Security Agency (UKHSA) said in November 2024 that an estimated 66,730 serious antibiotic-resistant infections were reported in 2023, surpassing pre-pandemic levels of 62,314 infections in 2019 — a 3.5% increase in the burden of AMR.
With AMR contributing to an estimated 35,200 deaths annually in the UK, the report calls for “particular focus” on several areas, including AMR awareness among the public and healthcare workers.
The report said that NHS England had “made progress with a key commitment to find innovative ways to pay for antibiotics” through a new subscription model.
The NHS antibiotic subscription model, first announced in 2019, incorporates a subscription-type fixed-fee contract value, where payment is not linked to the volume of antimicrobials supplied, but rather on the supplier satisfying specified performance requirements, such as surety of supply, stewardship and surveillance.
However, “the effects remain uncertain, given that the UK is only 3% of the global market for antibiotics,” the report says.
“Pharmaceutical companies will remain free to determine whether or not they invest more in developing new antimicrobials and are free to market these antimicrobials to other countries.”
The NAO report advised further work on understanding the impact of the UK’s aquatic environment on AMR, especially through the increasing incidence of untreated wastewater spills and inadequate monitoring of AMR in UK waterways, which are contributing to the spread of resistant pathogens.
In the report, the NAO added that UK’s storm overflow incidents have increased dramatically, worsening the contamination of waterways with AMR-linked substances.
In 2016, 862 storm overflows were monitored, averaging 15 spill events per site. However, by 2023, monitoring expanded to 14,000 storm overflows, with each site averaging 33 spills per year, the report said.
In August 2024, results of a study published in Environmental Toxicology and Chemistry revealed that 31 active pharmaceutical ingredients (APIs) were present in rivers in eight out of England’s ten national parks, with the most common APIs being cetirizine, metformin and fexofenadine.
The NAO report said the DHSC’s AMR plans had “limited ambitions” with regard to the environment.
Commenting on the report, Gareth Davies, head of the NAO, said: “AMR presents a major public health threat and addressing it is a multifaceted challenge.
“[The] government is responding but, so far, the results have been limited and the country needs to become more resilient to this long-term risk. [The] government needs to consider whether its existing commitments and other efforts across the public sector will be enough to achieve its 20-year vision to contain and control AMR.”
Geoffrey Clifton-Brown, chair of the House of Commons Public Accounts Committee, said: “While the UK has been bold in its ambitions to try to address this issue, progress, so far, has been limited and public awareness is low.
“In the shadow of COVID-19, this silent pandemic deserves equal attention to safeguard public health and the NHS. Unless measurable change to reduce the spread of AMR is achieved, there remains a grave threat to human life and society as we know it.”
